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Children with celiac disease often have persistent mucosal damage on gluten-free diet
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About one in five children with celiac disease who adhere to a gluten-free diet have persistent enteropathy, researchers found.
In addition, they found that neither symptoms nor positive immunoglobulin A (IgA) tissue transglutaminase (tTG) antibody serology test results were predictive of mucosal healing.
“These findings suggest the need not only for a baseline endoscopy to confirm the diagnosis of [celiac disease], but consideration of a repeat endoscopy to confirm remission,” the researchers wrote, adding that the management criteria of pediatric celiac disease may need to be revisited.
They performed a retrospective chart review of 103 celiac disease patients aged younger than 21 years who were seen at MassGeneral Hospital for Children between January 2012 and March 2015, and at Boston Children’s Hospital between January 2008 and December 2013. Their mean age at diagnosis was 10.6 years, 60% were girls, and all underwent a repeat endoscopy with duodenal biopsy at least 1 year after beginning on a gluten-free diet (median 2.4 years; range, 1-12 years; 91% with “excellent” diet adherence).
Overall, 19% of the patients had persistent enteropathy at the time of repeat endoscopy despite adhering to a gluten-free diet. Moreover, 43% of the patients with persistent enteropathy had elevated tTG levels compared with 32% if patients who had mucosal healing.
IgA tTG was a poor predictor of histology irrespective of symptom presence and duration of gluten-free diet, with a sensitivity of 43%, a specificity of 68%, a positive predictive value of 25% and a negative predictive value of 83%.
“These findings must be confirmed prospectively and systematically in order to evaluate the natural history of mucosal recovery in pediatric patients with [celiac disease] on a [gluten-free diet],” the researchers wrote. “Long term complications including growth trajectory must be monitored and further study evaluating available treatment options beyond the [gluten-free diet] and timing of subsequent endoscopies in patients found to have persistent enteropathy must be established.” – by Adam Leitenberger
Disclosures: One of the researchers reports he is a co-founder and stockholder of Alba Therapeutics, has received research support from Mead Johnson Nutrition, Inova Diagnostics and Regeneron, and is a consultant for Pfizer.
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